Developing a fully integrated tobacco curriculum in medical colleges in India.

BACKGROUND: This paper describes a pioneering effort to introduce tobacco cessation into India's undergraduate medical college curriculum. This is the first ever attempt to fully integrate tobacco control across all years of medical college in any low and middle income country. The development, pretesting, and piloting of an innovative modular tobacco curriculum are discussed as well as challenges that face implementation and steps taken to address them and to advocate for adoption by the Medical Council of India. METHODS: In-depth interviews were conducted with administrators and faculty in five medical colleges to determine interest in and willingness to fully integrate smoking cessation into the college curriculum. Current curriculum was reviewed for present exposure to information about tobacco and cessation skill training. A modular tobacco curriculum was developed, pretested, modified, piloted, and evaluated by faculty and students. Qualitative research was conducted to identify challenges to future curriculum implementation. RESULTS: Fifteen modules were successfully developed focusing on the public health importance of tobacco control, the relationship between tobacco and specific organ systems, diseases related to smoking and chewing tobacco, and the impact of tobacco on medication effectiveness. Culturally sensitive illness specific cessation training videos were developed. Faculty and students positively evaluated the curriculum as increasing their competency to support cessation during illness as a teachable moment. Students conducted illness centered cessation interviews with patients as a mandated part of their coursework. Systemic challenges to implementing the curriculum were identified and addressed. CONCLUSIONS: A fully integrated tobacco curriculum for medical colleges was piloted in 5 colleges and is now freely available online. The curriculum has been adopted by the state of Kerala as a first step to gaining Medical Council of India review and possible recognition.

Comparison of Health-care Utilization Pattern and its Correlates among the Tribal and NonTribal Population of Kerala.

BACKGROUND: The isolation from mainstream development activities, together with poverty and inaccessibility to health facilities made the tribal communities specifically vulnerable to various health problems. OBJECTIVES: This study aimed to compare the utilization of antenatal care, immunization, and supplementary nutrition services by tribal and nontribal mothers and its correlates in the selected districts. MATERIALS AND METHODS: The study was a comparative cross-sectional study. The study population comprised tribal and nontribal mothers utilizing antenatal care, immunization, and supplementary nutrition services. A multi-stage cluster sampling strategy was employed for the study. The Chi-square test was used to assess the association between antenatal care services utilization, utilization of immunization services, supplementary nutrition services utilization and sociodemographic variables, and other service characteristics. RESULTS: Effective utilization of antenatal care services was not seen in 5.6% of tribal mothers. The incidence of low-birth weight (≤2500) was significantly more among tribal mothers (31%) when compared to nontribal mothers (15%). The proportion of tribal children receiving complete immunization without delay was 74%, and among nontribal children, it was 78%. Effective immunization coverage was significantly lower among children of tribal mothers with education below high school level. Receipt of take-home ration was reported by nearly 90% of tribal and nontribal mothers. 90% of tribal mothers felt that quality of take-home ration that they received was of good quality. CONCLUSIONS: The comparison of health-care utilization restricted to the domains of antenatal care, immunization services, and supplementary nutrition suggests that the tribal mothers and children had a relatively comparable utilization pattern in most of the indicators measured.

Impediments to Optimal Health-care Utilization of a Particularly Vulnerable Tribal Group in Wayanad: A Qualitative Study.

INTRODUCTION: The pathways and mechanisms through which constraints that impede optimal utilization of the government health-care service provisions translate into health inequities among Particularly Vulnerable Tribal Groups seem to be an area that warrants research. OBJECTIVE: The objective is to explore and understand the mechanisms/pathways through which various factors result in health care inequity among the Kattunayakan tribe in Wayanad. MATERIALS AND METHODS: Designed as a qualitative case study, using observations and interviews with mothers, community members, and frontline health-care personnel, the study was conducted in a Kattunayakan hamlet in Wayanad. The data, in the form of digital audio recordings and field notes, were transcribed, coded, and analyzed using a thematic approach. RESULTS AND DISCUSSION: Axes of inquiry like access to health-care institutions, acceptability of the services provided, hurdles faced by the tribes, the health-care personnel, and how the system responded to these issues were explored. Disregard for the identity and culture of the tribes, geographical barriers for utilization and providing health services, proactive efforts from government systems, collaborations with private and professional bodies are important factors that possibly influence health inequities among tribes. CONCLUSION: Acknowledgment of the sociocultural identity of the tribes, gaining their trust, proactive efforts from the government machinery, innovative context-specific programs, strategic partnerships and a departure from the "blame the victim" philosophy are key in the effort to provide services that meet the health-care needs of the tribes.

Level of Physical Activity in Population Aged 16 to 65 Years in Rural Kerala, India.

Kerala is a state in India with a high prevalence of cardiovascular diseases and diabetes. In order to control these diseases, the prevalence of modifiable risk factors such as low physical activity need to be studied. For this a cross-sectional study was conducted to assess the level of physical activity among 240 residents aged between 15 and 65 years in Kulappuram, a village in north Kerala. Low level of physical activity was seen in 65.8% of the study participants. The average duration of moderate to vigorous intensity physical activity per day in different domains such as work, travel, and recreation were 40.5, 10.1, and 12.7 minutes, respectively. The average duration of sedentary activities was 284.3 minutes per day. The level of physical activity was more among those engaged in unskilled work (adjusted odds ratio = 4.32; confidence interval = 1.38-13.51) and unmarried persons (adjusted odds ratio = 3.65; confidence interval = 1.25-10.65). No statistically significant difference in physical activity level was seen in different age, education, religious, and economic categories. The study concludes that the physical activity level was low in the study population.

Compliance with infection control practices in sputum microscopy centres: a study from Kerala, India.

BACKGROUND: One of the strategies of the Revised National Tuberculosis Control Programme in India to achieve tuberculosis control is by increasing case detection through a nationwide network of designated microscopy centres (DMC). Practice of standard precautions for infection control in these DMCs is very important to prevent transmission of infection not only to the laboratory personnel, but also to the general population. However, in India this has not been evaluated by an external agency. METHOD: A cross-sectional study was carried out to assess knowledge, facilities and compliance regarding infection control practices (ICP) in all 38 DMCs in Kannur district, Kerala, India, in 2015. Using observations and interviews, the investigators collected data in a structured format. RESULTS: Overall knowledge about infection control was found to be satisfactory among 29% of laboratory technicians. Overall facilities for infection control were satisfactory in 61% of the DMCs, while adherence to ICP was satisfactory in 45% of the DMCs. Knowledge regarding ICP was better in government DMCs, whereas facilities for ICP and adherence to biomedical waste management guidelines were better in private DMCs. CONCLUSION: Given the higher risk of infection among laboratory technicians, there is an urgent need to address the shortcomings in infection control practices.

Contexte : Une des stratégies du Programme national révisé de lutte contre la tuberculose (RNTCP) en Inde consiste à lutter contre la tuberculose en augmentant la détection des cas à travers un réseau national de Centres de Diagnostic par Microscopie (DMC). La mise en oeuvre des précautions standard de lutte contre les infections dans ces DMC est très importante pour prévenir la transmission des infections, non seulement vis-à-vis du personnel de laboratoire, mais également vis-à-vis de la population générale. Cependant, en Inde, ceci n'a pas été évalué par une agence externe.Méthode : Une étude transversale a été réalisée pour évaluer les connaissances, la structure et l'adhésion aux pratiques de lutte contre l'infection (ICP) dans les 38 DMC du district de Kannur, état du Kerala, Inde en 2015. Grâce à des observations et à des entretiens, les investigateurs ont recueilli des données dans un format structuré.Résultats : Les connaissances d'ensemble relatives à la lutte contre l'infection ont été jugées satisfaisantes pour 29% des techniciens de laboratoire. Le niveau d'ensemble des centres en matière de lutte contre l'infection a été satisfaisant dans 61% des DMC. L'adhésion aux pratiques de lutte contre l'infection a été satisfaisante dans 45% des DMC. Les connaissances relatives aux pratiques d'ICP ont été meilleures dans les DMC du gouvernement tandis que les installations et l'adhésion aux directives de gestion des déchets biomédicaux ont été meilleures dans les DMC privés.Conclusion : Connaissant le risque très élevé d'infection parmi les techniciens de laboratoire, il y a un besoin urgent de corriger les déficiences des pratiques de lutte contre l'infection.

Marco de referencia: Una de las estrategias del Programa Nacional Revisado contra la Tuberculosis de la India consiste en controlar la enfermedad al aumentar la detección de casos por conducto de una red nacional de centros de microscopia diagnóstica (DMC). La práctica de las precauciones corrientes de control de las infecciones en estos centros es muy importante con el fin de evitar la transmisión no solo al personal de laboratorio, sino también a la población general. Sin embargo, ningún organismo externo ha evaluado estas prácticas en el país.Método: Se llevó a cabo un estudio transversal con el fin de evaluar los conocimientos, la adecuación de los establecimientos y el cumplimiento de las prácticas en materia de control de las infecciones (ICP) en 38 DMC del distrito de Kannur en el estado de Kerala en la India en 2015. Los investigadores recogieron datos mediante observaciones y entrevistas estructuradas.Resultados: En general, el 29% del personal auxiliar de laboratorio poseía un grado satisfactorio de conocimientos sobre el control de las infecciones; el 61% de los DMC contaba con dispositivos adecuados de ICP y en el 45% se observó el cumplimiento de las normas. El conocimiento de las ICP fue mayor en los DMC del sector público, pero los dispositivos de los establecimientos y el cumplimiento de las directrices de eliminación de los desechos biológicos fueron de mejor calidad en los DMC del sector privado.Conclusión: Teniendo en cuenta el mayor riesgo de exposición a las infecciones que presenta el personal auxiliar de laboratorio, existe una necesidad urgente de abordar las deficiencias observadas en las prácticas de control de las infecciones.

Prevalence of coronary heart disease in the rural population of Thiruvananthapuram district, Kerala, India.

To establish the prevalence, with 95% confidence limits, of some of the indicators of coronary heart disease in the rural population of Thiruvananthapuram district, Kerala state, India, we did a field survey on a cluster sample with probability proportionate to size (PPS sample) of 500 households from five villages. Altogether the sample consisted of 1253 individuals who were more than 25 years of age, of which 1130 responded (90%). The survey instruments included the Malayalam translation of the Rose questionnaire, a standard 12-lead electrocardiogram with a battery operated portable electrocardiograph machine, blood pressure measurements using a mercury sphygmomanometer, and routine anthropometric measurements. The prevalence rates estimated were: (a) ECG changes suggestive of coronary heart disease, 36/1000 (95% C.L., 18, 55), (b) Rose questionnaire angina, 48/1000 (95% C.L. 35, 62), (c) definitive evidence of coronary heart disease, 14/1000 (95% C.L., 7, 21), (d) possible evidence of coronary heart disease, 74/1000 (95% C.L., 55, 93). Prevalence of major risk factors were, (a) hypertension by the WHO criteria, 179/1000 (95% C.L., 137, 221), (b) smoking, 219/1000 (95% C.L., 151, 287), (c) diabetes, 40/1000 (95% C.L., 17, 63), (d) obesity, 55/1000 (95% C.L., 6, 104). We have found that objective criteria indicate a lower prevalence of coronary heart disease in rural Thiruvananthapuram district when compared to studies from urban centres in India, but the prevalence of angina by Rose questionnaire is greater.

Searching for justice for body and self in a coercive environment: sex work in Kerala, India.

Sex workers in Kerala, India, live in a coercive environment and face violence from the police and criminals, lack of shelter, lack of childcare support and have many physical and mental health problems. This paper documents the environment in which women have been selling sex in Kerala since 1995, and their efforts to claim their rights. It is based on sex workers' own reports and experiences, a situation analysis and a needs assessment study by the Foundation for Integrated Research in Mental Health. Involvement in HIV/AIDS prevention projects first gave sex workers in Kerala an opportunity to come together. Some have become peer educators and distribute condoms but they continue to be harassed by police. Most anti-trafficking interventions, including rescue and rehabilitation, either criminalise or victimise sex workers, and sex workers reject them as a solution to sex work. They understand that the lack of sexual fulfillment in other relationships and their own lack of access to other work and resources are the reasons why commercial sex flourishes. Sex workers are not mere victims without agency. They have a right to bodily integrity, pleasure, livelihood, self-determination and a safe working environment. Sex workers are organising themselves for these objectives and demand decriminalisation of sex work.